title: Depressive symptoms and suicide in 56,000 older Chinese: a Hong Kong cohort study.
abstract: OBJECTIVE
  To examine dose-response associations between depressive symptoms and suicide and modification effects of sex, age and health status in older Chinese.
  
  
  METHODS
  We used the Chinese version of the 15-item Geriatric Depression Scale (GDS) to measure depressive symptoms (GDS score ≥ 8) and Cox regression to examine association with suicide mortality in a population-based cohort of 55,946 individuals, aged 65 years or above, enrolled from July 1998 to December 2000 at one of 18 Elderly Health Centres of Hong Kong Department of Health. The cohort was followed up for suicide mortality till 31 March 2009 (mean follow-up 8.7 years).
  
  
  RESULTS
  Depressive symptoms were associated with suicide in men [hazard ratio (HR) 2.03, 95% confidence interval (CI) 0.96-4.29] and women (HR = 2.36, 95% CI 1.31-4.24) after adjusting for age, education, monthly expenditure, smoking, alcohol drinking, physical activity, body mass index, health status, and self-rated health. There was no threshold for GDS score and suicide in either sex. Age, sex and health status did not modify the association.
  
  
  CONCLUSIONS
  Depressive symptoms predict higher suicide risk in older Chinese in a dose-response pattern. These associations were not attenuated by adjustment for health status, suggesting that depressive symptoms in older people are likely to be an independent causal factor for suicide. The GDS score showed no threshold in predicting suicide risk, suggesting that older people with low GDS scores deserve further attention and those with very high scores need urgent intervention.
authors.affiliation: Department of Community Medicine, School of Public Health, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
authors.forename: Wen Jie
authors.initials: WJ
authors.lastname: Sun
authors.forename: Lin
authors.initials: L
authors.lastname: Xu
authors.forename: Wai Man
authors.initials: WM
authors.lastname: Chan
authors.forename: Tai Hing
authors.initials: TH
authors.lastname: Lam
authors.forename: C Mary
authors.initials: CM
authors.lastname: Schooling
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000523:psychology / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003866:Depressive Disorder / Q000208:ethnology* / Q000209:etiology / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D005102:Health Expenditures; D006305:Health Status Indicators; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008019:Life Style; D008297:Male; D015995:Prevalence; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012959:Socioeconomic Factors; D013405:Suicide / Q000208:ethnology* / Q000706:statistics & numerical data / Q000639:trends; D016019:Survival Analysis